Carcinogenicity of azathioprine: an S-AR investigation

Besides its use in the treatment of a variety of presumed autoimmune diseases, azathioprine is given as an immunosuppressant to patients who have had renal transplants. Though epidemiological studies have provided "sufficient" evidence of its carcinogenicity in humans, the carcinogenicity tests in rats and mice are considered to be inconclusive because of limitations in the design and results of these tests (IARC, 1981, 1987). Rosenkranz and Klopman (1991) used the CASE program to identify the structural features responsible for its carcinogenicity. They concluded that this genotoxic chemical was a carcinogen due to the presence of the molecular fragment C"-S-C=. The finding was based on the presence of this biophore fragment in five other compounds, namely: 2-amino-5-nitrothiazole, 2-mercaptobenzothiazole, fenthione, 4,4'-thiodianiline and nithiazide. Recently, Ashby (1992) has expressed concern over the validity of their findings. With the aim of contributing to this debate on the mechanism of carcinogenicity of azathioprine, we have analyzed the structural basis of carcinogenicity of azathioprine and the five support compounds using the carcinogenicity predictor of our toxicity prediction program, TOPKAT. The results, more in line with Ashby's concerns, indicate that no molecular fragment involving the S atom is associated with the carcinogenic properties of these molecules. According to the TOPKAT program the carcinogenicity, if any, of azathioprine is due to the NO2 electrophile because its other major structural features are found to be either associated with non-carcinogenicity or do not discriminate carcinogens from non-carcinogens.